Suture system

ABSTRACT

A suturing instrument includes an elongate body member; a distal tip assembly movably coupled to the elongate body member; a needle deployment system located in the distal tip assembly, the needle deployment system including a forward-deploying needle carrier; and a catch located on the distal tip assembly to receive and retain a needle coupled to the forward-deploying needle carrier, the catch being positioned on the distal tip assembly such that a distal path segment of the needle carrier&#39;s path is intercepted by the catch.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application of U.S. patentapplication Ser. No. 13/284,267, filed on Oct. 28, 2011, now U.S. Pat.No. 8,518,058, which is a continuation of U.S. patent application Ser.No. 12/510,464, filed on Jul. 28, 2009, which is a continuation of U.S.patent application Ser. No. 10/785,830, filed on Feb. 24, 2004, now U.S.Pat. No. 7,582,096, which in turn is a continuation of U.S. patentapplication Ser. No. 09/939,114, filed on Aug. 24, 2001, now U.S. Pat.No. 6,719,764. The entire contents of each of the above-referencedapplications are incorporated herein by reference in their entirety.

TECHNICAL FIELD

The invention related to devices and methods for placing suture.

BACKGROUND INFORMATION

Until recently, all but the simplest surgical procedures required thephysician to make a large opening in the human body in order to exposethe area requiring surgical repair. Today instruments are available thatallow for viewing of internal body regions through a small puncturewound without exposing the entire body cavity. These instruments, calledendoscopes, an be used in conjunction with specialized surgicalinstruments to detect, diagnose, and repair areas of the body thatpreviously required open surgery to access.

Some surgical instruments used in endoscopic procedures are limited bythe manner in which they access the areas of the human body in need ofrepair. In particular, the instruments may not be able to access tissueor organs located deep within the body or that are in some wayobstructed. Also, many of the instruments are limited by the way theygrasp tissue, apply a suture, or recapture the needle and suture.Furthermore, many of the instruments are complicated and expensive touse due to the numerous parts and/or subassemblies required to make themfunction properly. Suturing remains a delicate and time-consuming aspectof most surgeries, including those performed endoscopically.

SUMMARY OF THE INVENTION

The present invention allows for the performance of surgical proceduresthat involve the passing of sutures through tissue, for example, in alocation that is facilitated by the suturing instrument deploying thesuture in a forward-facing direction in relation to the suturinginstrument. In addition, this invention provides for the catching andretrieval of the suture after it is passed through the tissue, forexample. In particular this suturing instrument may be placed orpositioned in the body such that a suture may be passed into a tissue ofthe body while the face of the distal end of the instrument abuts thetissue. Such a surgical device may allow for surgical procedures notpreviously possible or improve upon the performance of known surgicalprotocols.

In one aspect, the invention relates to a suturing instrument. Thesuturing instrument includes an elongate body member, a needledeployment system disposed at a distal portion of the elongate bodymember. The suture deployment system includes a forward-deploying needlecarrier including a needle for tissue penetration and a catch to receiveand retain the needle. The inclusion of a needle catch in the needledeployment system prevents the need for the introduction of a secondsurgical instrument into the location of the body where the suture waspassed in order to retrieve the suture.

In some embodiments, the suturing instrument may include a deploymentcontroller having a proximal end and a distal end. The deploymentcontroller extends substantially along a longitudinal axis of theelongate body member to the distal portion of the elongate body member,where the distal end of the deployment controller is coupled to theneedle carrier and moves the suture carrier between a retracted positionand a deployed position. The proximal end of the deployment controllermay be coupled to an actuator. In some embodiments, the deploymentcontroller guides the suture carrier along a path which includes aproximal curved path segment such that the needle carrier initiallytravels away from the elongate body member and then toward the elongatebody member.

Various embodiments according to the foregoing aspect of the inventioncan include the following features. A suture can include a needle, andthe needle can be permanently fixed to an end of the suture. The needlefixed on the suture can insert into the needle carrier. Also, the needlecan be plastic, metal, or polymer compound. In addition, the suturinginstrument can include a catch to receive and retain the needle, wherethe catch is positioned on the body member such that a distal segment ofthe needle carrier's path is intercepted by the catch. Additionally, thesuturing instrument may include a second needle carrier and a secondforward-facing exit port. Further, the deployment controller may becoupled to the suture carrier with a flexible driver member. Theflexible driver member may be manufactured of an alloy that includes atleast or exclusively nickel and titanium.

In yet another embodiment, the invention relates to a suturinginstrument including an elongate body member having a longitudinal axisand a distal tip needle deployment assembly joined with a distal end ofthe elongate body member such that the distal tip assembly is free torotate axially about the longitudinal axis of the elongate body member.The distal tip suture deployment assembly includes a forward-facingneedle exit port and a curved needle carrier channel formed in thedistal tip needle deployment assembly, a curved needle carrier movablypositioned in the curved needle carrier channel, a suture with anattached needle tip, and a deployment controller including a proximalend and a distal end. The deployment controller extends substantiallyalong the longitudinal axis of the elongate body member to the distalend of the elongate body member, where the distal end of the deploymentcontroller is coupled to the distal tip suture deployment assembly andmoves the curved suture carrier through the curved suture carrierchannel as the deployment controller moves between a retracted positionand a deployed position. Additionally, the proximal end of thedeployment controller may be coupled to an actuator.

In still another embodiment, the invention relates to a suturinginstrument including a body member defining a forward-facing exit portand a carrier channel, a carrier movably positioned in the carrierchannel, and a surgical needle attached with an interference fit on adistal end of the needle carrier. The needle carrier has a retractedposition within an interior region of the body member and a deployedposition exterior to the body member. The needle carrier is configuredwithin the needle carrier channel such that the needle carrier exits theinterior region of the body member through the forward-facing exit port.In addition, the forward-facing exit port, needle carrier channel, andneedle carrier can be located in a distal tip assembly coupled to thebody member, and the distal tip assembly can be coupled to the bodymember such that the distal tip assembly is free to rotate axially abouta longitudinal axis of the body member. In addition, the needle carrierand needle catch can be located in a distal tip assembly coupled to theelongate body member at a pivot joint such that the distal tip assemblyis free to deflect about the pivot joint. Such embodiments describedabove allow for enhanced control of the precise placement or position ofthe distal tip of the suturing instrument.

An additional aspect of the invention relates to a method for placing asuture in tissue. The method includes the steps of placing a suturinginstrument enclosing a needle carrier having an attached needle fortissue penetration, deploying the needle carrier out of the suturinginstrument through a forward-facing exit port such that the needlecarrier exits an interior region of the suturing instrument through theexit port along a path which approaches being substantially tangentialto an outer surface of the suturing instrument surrounding theforward-facing exit port, and capturing a needle attached to a sutureand carried by the needle carrier in a catch that receives and retainsthe needle. The needle carrier is movably positioned within a needlecarrier channel adjacent the tissue to be sutured.

In one embodiment, deploying the forward-deploying needle carrier out ofthe suturing instrument through a forward-directed exit port includesactivating a deployment controller, which includes a distal end thatextends substantially along a longitudinal axis of an elongate bodymember to the distal portion of the elongate body member. The distal endof the deployment controller is coupled to the needle carrier tofacilitate movement of the needle carrier between a retracted positionand a deployed position. In another embodiment, the invention furtherincludes activating an actuator coupled to a proximal end of thedeployment controller. In yet another embodiment, deploying theforward-deploying needle carrier out of the suturing instrument througha forward-directed exit port includes activating the deploymentcontroller. The deployment controller is configured to guide the needlecarrier along a path that includes a proximal curved path segmentleading initially away from the elongate body member and then towardsthe elongate body member.

In yet another embodiment, the invention further includes placing asuturing instrument enclosing a second forward-deploying needle carrier.This embodiment may facilitate passing two sutures in the same generallocation without removing the surgical device from body in order toreload the needle carrier with a second needle. The needle carrierincludes a needle and the second forward-deploying needle carrier ismovably positioned within a needle carrier channel adjacent the tissueto be sutured. The needle may also include a suture attached to theneedle. In another embodiment, the invention relates a method thatincludes the needle carrier following a path that includes a distal pathsegment. As the needle carrier traverses the distal path segment theneedle is intercepted by the catch.

In another aspect, the invention relates to a method for shortening thepelvic floor including the steps of placing a suturing instrumentenclosing a forward-deploying needle carrier including a needle adjacentto the tissue of the pelvic floor, deploying the suturing instrumentsuch that the suture is passed through the tissue of the pelvic floor,and tightening the suture such that the pelvic floor buckles and iseffectively shortened in height.

In one embodiment, the invention further comprises a second deploying ofthe suturing instrument such that the suture is passed through thetissue of the pelvic floor prior to tightening the suture such that thepelvic floor buckles and is effectively shortened in height.

In another embodiment, the invention relates to placing a suturinginstrument enclosing a forward-deploying needle carrier including aneedle adjacent to the tissue of the pelvic floor, in which the suturinginstrument includes an elongate body member, a needle deployment systemdisposed at a distal portion of the elongate body member. The needledeployment system includes the forward-deploying needle carrier and acatch disposed on the elongate body member to receive and retain theneedle. In yet another embodiment, the suturing instrument furtherincludes a deployment controller that includes a distal end. Thedeployment controller extends substantially along a longitudinal axis ofthe elongate body member to the distal portion of the elongate bodymember, where the distal end of the deployment controller is coupled tothe needle carrier to facilitate movement of the needle carrier betweena retracted position and a deployed position.

These and other objects, along with advantages and features of thepresent invention herein disclosed, will become apparent throughreference to the following description, the accompanying drawings, andthe claims. Furthermore, it is to be understood that the features of thevarious embodiments described herein are not mutually exclusive and canexist in various combinations and permutations.

BRIEF DESCRIPTION OF THE DRAWINGS

In the drawings, like reference characters generally refer to the sameparts throughout the different views. Also, the drawings are notnecessarily to scale, emphasis instead generally being placed uponillustrating the principles of the invention. In the followingdescription, various embodiments of the present invention are describedwith reference to the following drawings.

FIG. 1 is a perspective view of the general structure of one embodimentof the present invention.

FIG. 2 is a partial-cutaway elevation of the general structure ofanother embodiment of the present invention.

FIG. 3 is a side elevation view of a needle and suture.

FIG. 4 is a partial-cutaway elevation of a needle with an attachedsuture in a needle carrier.

FIGS. 5A and 5B are perspective views of an alternate catch mechanismwith a suture carrier.

FIG. 6 is an end view illustrating the formed suture tip catch.

FIG. 7 is a cross-sectional view of the suture tip catch shown in FIG.6.

FIGS. 8A-D are perspective views of the general structure of anembodiment of the present invention.

FIGS. 9A-D illustrate a single suture-pass surgical method.

FIGS. 10A-F illustrate a double suture-pass surgical method

DETAILED DESCRIPTION

Embodiments of the present invention are described below. It is,however, expressly noted that the present invention is not limited tothese embodiments, but rather the intention is that modifications thatare apparent to the person skilled in the art are also included.

FIG. 1 illustrates the general structure of one embodiment of thepresent invention. FIG. 1 depicts a suturing instrument 100 includinghandle 105, an elongate body 110, a distal tip 115, and an actuatorbutton 120. This embodiment of the present invention is particularlywell suited to, for example, the fixation of sutures to the pelvic floorduring a procedure to effectively shorten the pelvic floor for thetreatment of hypermobility. As will become apparent, this embodimentincludes features that prevent the need for positioning the targettissue between the needle exit port and the needle catch on the side ofa distal tip while placing the suturing instrument in the body. Theembodiment of FIG. 1 allows for the positioning of the target tissuebetween the needle exit port and the needle catch on the front face ofthe distal tip during the placement of the suturing device into thebody. The end of the distal tip 4 may be pressed against the targettissue in order to throw a suture into the tissue.

FIG. 2 depicts an alternative embodiment of a suturing device 200, whichincludes a handle 205, an elongate body housing 210, a distal tip 215,and an actuator button 220. The button 220 operates a drive screw 225and compression spring 230, which are housed in the proximal end of thebody housing 210. The button 220 is mechanically linked to the driveshaft 235, which moves a gear drive 240, which in turn drives a gear245. The gear 245 is coupled to a link drive pin 250, which is itselfcoupled to a needle carrier 255.

The needle carrier 255 shown in FIG. 2 is circular; however, it iscontemplated that the above embodiment may be modified to include needlecarriers having non-circular contours (e.g., helical, elliptical, orstraight). Although a single needle carrier 255 is shown in the figure,the above configuration may in fact contain more than one needlecarrier. For example, multiple needle carriers may be actuated anddriven independently by dividing the deployment controls and the needlecarrier drivers into separate adjacent members with separate handles orcontrolled by a single handle.

Referring to FIG. 3, device 100, 200 according to the present inventionmay incorporate a length of suture material 300 with a needle tip 305.The needle tip 305 is held by a needle carrier 255. The needle carrier255 and needle tip 305 are deployable out of the housing 110, 210 andinto tissue. Deployment is via an actuator button 120, 220 coupled torigid driving members which are suitably attached to the needle carrier255. With renewed reference to FIG. 2, the actuator button 220 ispushed, simultaneously driving the needle carrier 255 and needle tip 305into a catch mechanism 260. The needle carrier 255 is retracted backinto the housing 210 and the needle tip 305 remain in the catchmechanism 260.

A needle tip 305 comprises a body 310 having a shoulder 315. Theshoulder 315 is the rear surface of the needle tip body 310 that engagesa catch 260 in the manner of a flange. A length of suture material 300is inserted into a hole located on the body 310 and attached to theneedle tip 305 thereby. The suturing material 300 is attached to thebody 310 by any suitable means, such as crimping or adhesive bonding. Itshould be understood that the illustrated arrow-shaped body 310 ismerely illustrative, and the shape may be varied to fit a particularapplication. The needle tip 305 can be manufactured from a plastic,metal, or polymer compound and can be formed by, for example, extrusion,molding, or machining. Furthermore, the nature of the suture 300 isimmaterial to the present invention. The needle tip 305 of the presentinvention may be used with a suture of any type, length, diameter, andcharacteristics.

Referring now to FIG. 4, a needle carrier 400 comprises a body 405defining a lumen 410, a needle holder 415 to receive a needle tip 420for tissue penetration. The lumen 410 is in communication with theneedle holder 415 at one end and with an aperture 425 at the other end.The needle holder 415 is sized and shaped to releasably engage theneedle tip 420. A length of suture material 430 attached to the needletip 420 is inserted into the needle holder 415, through the lumen 410,and out the aperture 425. The attached needle tip 420 is then releasablyengaged with the needle holder 415. Alternatively, the needle carrier400 can be a solid piece with the suture 430 disposed in a groove in theouter surface of the needle carrier 400.

The needle tip 420 is releasably engaged with the needle holder 415 sothat the shoulder 435 protrudes slightly from the needle carrier 400.The rear surface of the shoulder 435 faces away from the sharpened tipof the needle tip 420. The needle tip 420 and the needle holder 415 areengaged such that the needle tip body 440 is held in place by frictionalforces when the needle carrier 400 is extended forward. The needle tipbody 440 is released from the needle holder 415 when the needle carrier400 is retracted from a catch. This is facilitated by dimensioning theshoulder 435 so as to be retained by the catch 260 when the needlecarrier 400 exits the catch 260. The interaction of the needle carrier400 and various catches is described in greater detail with respect toFIGS. 5A and 5B.

FIGS. 5A and 5B depict alternate catches and illustrate their operation.Referring to FIG. 5A, the catch 500 includes a series of openings 505defined by successive ribs 510. The catch 500 receives a needle carrier(not shown) and a suture 515 with a needle tip 520 through opening 505,the ribs 510 deflecting slightly to allow the suture carrier and needletip 520 to pass through. After the needle tip shoulder 525 has clearedthe ribs 510 and the suture carrier has been withdrawn, therebyreleasing the needle tip 520, the ribs 510 spring back to their originalposition defining the openings 505. The openings 505 are chosen to besmaller in dimension than the needle tip shoulder 525. This causes thecatch 500 to retain the needle tip 520 because, due to the flat rearsurface of the tip shoulder 525, needle tip 520 cannot pass back throughan opening 505. When it is necessary to remove the needle tip 520 fromthe catch 500, it may be moved toward an enlarged portion 530 of opening505; enlarged portion 530 is sized to allow the needle tip shoulder 525to pass through without resistance. The catch 500 is preferablyconstructed of thin stainless steel of high temper, such as ANSI 301full hard. The catch 500 may be fabricated by means of stamping, lasermachining, or chemical etching.

Referring now to FIG. 5B, a catch 535 includes a frame 540 to which isattached a woven mesh 545. Threads 550 creating the woven mesh 545 maybe nylon, polyester, or the like woven in a common over/under pattern.The weaving of the threads 550 creates windows 555 in the mesh throughwhich a needle carrier 560 may be passed. The needle carrier 560 isconstructed such that the shoulder 565 of the needle tip 570 is largerthan the windows 555, or conversely, threads 550 are woven such that thewindows 555 are smaller than the needle tip shoulder 565. The needle tip570 of the needle carrier 560 pushes the threads 550 aside, allowing theneedle tip shoulder 565 to pass through the holes 555. Upon withdrawalof the needle carrier 560, the threads 550 return to their originalpositions and the catch 535 retains the needle tip 570 and attachedsuture 575 (once again due to the flat rear surface of tip shoulder 565,which is larger in size than the windows 555).

Referring to FIG. 6, the catch 600 includes openings 605 defined by ribs610. The configuration and function of the formed tip catch 600 issimilar to that described earlier with respect to FIG. 5A. When thecatch 600 is fabricated by means of chemical etching, the preferredmethod is to etch from a single side, a technique known in the art assingle sided etching. When the catch 700 is etched from a single side,the ribs 705 have a tapered cross 20 section 710 as shown in FIG. 7. Thetapered cross section 710 helps to guide the needle tip 520 of theneedle carrier into the catch openings 715, thereby minimizing thechance of the sharpened end of the needle tip 520 hitting the top of theribs 705.

FIGS. 8A-D depict an alternative embodiment of a suturing device 800,which includes a handle 805, an elongate body housing 810, a distal tip815, an actuator button 820, a pivot joint 825, and a distal tipdeflection control lever 830. In FIG. 8A, the control lever 830 ismechanically linked to the distal tip 815 by a cranking assembly thatallows the movement of the control lever 830 from a forward position 835to a back position 840 to cause the deflection of the distal tip 815about a pivot joint 825 from a tip up position 845 to a tip downposition 850. Moreover, distal tip 815 may be rotatable about the axisof the elongate body housing 810 as shown in FIGS. 8B-8D. For example,an actuator button 820 may be secured to the distal tip 815 throughhousing 815. Rotation of the actuator button 820 causes a correspondingrotation of the distal tip 815. The actuator button 820 may include adirectional indicator 855 such as a pointed shape on the actuator button820 that is aligned with the plane in which the needle tip (not shown)travels during deployment of the device 800. FIGS. 8C and D depict therotation of 5 the distal tip 815 by 90 degrees in alternative directionsfrom the starting position depicted in FIG. 8B. Additionally, the rangeof rotation of the distal tip 815 may include a complete 360 degreesabout the axis of the elongate body housing 810.

Current surgical methods of treating hypermobility in women include boneanchoring or suture placements by invasive techniques. Hypermobility inwomen can be relieved by a minimally invasive surgical method thatinvolves passing a suture into the pelvic floor and tightening thesuture in order that the pelvic floor buckles or otherwise shortens inlength. A suturing device as described above may be used to access thepelvic floor through a small anterior vaginal incision. The end of thedistal tip of a suturing device can be pressed against the pelvic floorand a suture can be thrown. The suture can be tightened manually or by asurgical device know in the art. Although this description relates to aspecific application, i.e., shortening the pelvic floor via atransvaginal approach, it is to be understood that the principles andconstruction herein described may be applied to other areas of the humanbody, and for other procedures requiring suturing body structures.

FIGS. 9A-D depict a surgical method for treating hypermobility in women.The surgical 20 method includes positioning the distal tip 900 of asurgical device 905 (partially shown) against the surface of the pelvicfloor 910 (FIG. 9A) and deploying the device so that the needle carrier915, which is carrying a needle tip (not shown) with an attached suture920, moves in the direction of the arrow and pierces the pelvic floor910 (FIG. 9B). The path of motion of the needle carrier makes twopassages of the tissue of the pelvic floor 910. The needle carrier 915carries a needle tip into the needle catch 925 in the distal tip 900. InFIG. 9C the needle carrier 915 is retracted into the distal tip 900, theneedle tip is retained in the needle catch 925 and the distal tip 900 isretracted from the surface of the pelvic floor 910. The suture 920remaining in the pelvic floor 910 (FIG. 9C) is tightened and tied thuscausing the buckling an effective shortening of the pelvic floor 910(FIG. 9D).

FIGS. 10A-F depict a surgical method for treating hypermobility in womeninvolving the passing of two sutures into the pelvic floor. The surgicalmethod includes placing the distal tip 1000 of a surgical device 1005(partially shown) against the surface of the pelvic floor 1010 anddeploying the device so that the needle carrier 1015, which is carryinga needle tip 1020 with an attached suture 1025, moves in the directionof the arrow and pierces the pelvic floor 1010 (FIG. 10A). The needlecarrier 1015 carries a needle tip 1025 into the needle catch 1030 in thedistal tip 1000. In FIG. 10B the needle carrier 1015 is retracted intothe distal tip 1000, and while the needle tip is retained in the needlecatch 1030 the distal tip 1000 is retracted from the surface of thepelvic floor 1010. The needle tip 1020 is extracted from the needlecatch 1030 10 (FIG. 10B) and reloaded into the needle carrier 1015 (FIG.10C). In FIG. 10D the suture 1025 is placed in the pelvic floor 1010 ina second location a certain distance from the first suture placement. InFIG. 10E the needle carrier 1015 is retracted into the distal tip 1000,and the needle tip is retained in the needle catch 1030. The retentionof the needle tip 1020 in the needle catch 1030 allows for the retentionand control of the leading end of the suture 1025 while the distal tip1000 is refracted from the surface of the pelvic floor 1010 (FIG. 10E).In FIG. 10F the suture 1025 remaining in the pelvic floor 1010 istightened and tied thus causing the buckling and effective shortening ofthe pelvic floor 1010. The distance between the two suture placements isdirectly proportional to the degree to which the pelvic floor 1010 canbe shortened. The degree to which the pelvic floor 1010 is shortened canalso be controlled by how tightly the suture 1025 is drawn in and tied.

Having described certain embodiments of the invention, it will beapparent to those of ordinary skill in the art that other embodimentsincorporating the concepts disclosed herein can be used withoutdeparting from the spirit and the scope of the invention. Accordingly,the described embodiments are to be considered in all respects only asillustrative and not restrictive.

What is claimed is:
 1. A suturing instrument comprising: an elongatebody member; a distal tip assembly movably coupled to the elongate bodymember, the distal tip assembly having a distal face defining a distalend of the suturing instrument, the distal face configured to abuttarget tissue when the suturing instrument is inserted into a body of apatient in a distal direction with respect to an operator of thesuturing instrument; a needle deployment system located in the distaltip assembly, the needle deployment system including a distal-deployingneedle carrier and a needle coupled to the distal-deploying needlecarrier, the distal-deploying needle carrier configured to extend out ofthe distal face of the distal tip assembly; and a catch located on thedistal face of the distal tip assembly to receive and retain the needlecoupled to the distal-deploying needle carrier, the catch beingpositioned on the distal tip assembly such that a path segment of a pathof the distal-deploying needle carrier is intercepted by the catch. 2.The suturing instrument as defined in claim 1, further comprising adeployment controller having a distal end, the deployment controllerextending substantially along a longitudinal axis of the elongate bodymember to a distal portion of the elongate body member, wherein thedistal end of the deployment controller is coupled to the needle carrierto facilitate movement of the needle carrier between a retractedposition and a deployed position.
 3. The suturing instrument as definedin claim 2, further comprising an actuator coupled to a proximal end ofthe deployment controller.
 4. The suturing instrument as defined inclaim 2, wherein the deployment controller is configured to guide theneedle carrier along a curved path segment of the path, the curved pathsegment leading initially away from the distal tip assembly and thentowards the distal tip assembly.
 5. The suturing instrument as definedin claim 2, further comprising a flexible drive member coupling thedeployment controller to the needle carrier.
 6. The suturing instrumentas defined in claim 5, wherein the flexible drive member comprises analloy including nickel and titanium.
 7. The suturing instrument asdefined in claim 1, further comprising a suture coupled to the needle.8. The suturing instrument as defined in claim 7, wherein the needle isconfigured to be inserted into the needle carrier.
 9. The suturinginstrument as defined in claim 1, wherein the distal tip assembly ismovably coupled to the elongate body member such that the distal tipassembly is free to rotate about a longitudinal axis with respect to theelongate body member.
 10. The suturing instrument as defined in claim 1,wherein the distal tip assembly is movably coupled to the elongate bodymember at a pivot joint such that the distal tip assembly is free todeflect about the pivot joint.
 11. A suturing instrument comprising: ahandle disposed on a proximal end portion of the suturing instrument; anelongate body member coupled to the handle; a distal tip assemblymovably coupled to the elongate body member, the distal tip assemblyhaving a distal face defining a distal end of the suturing instrument,the distal face configured to abut target tissue when the suturinginstrument is inserted into a body of a patient in a distal directionwith respect to an operator of the suturing instrument; a needledeployment system disposed in the distal tip assembly, the needledeployment system having a distal-deploying needle carrier and a needlecoupled to the distal-deploying needle carrier, the distal-deployingneedle carrier configured to extend out of the distal face of the distaltip assembly; and a catch disposed on the distal face of the distal tipassembly to receive and retain the needle.
 12. The suturing instrumentof claim 11, further comprising: a deployment controller having a distalend, the deployment controller extending substantially along alongitudinal axis of the elongate body member to a distal portion of theelongate body member, wherein the distal end of the deploymentcontroller is coupled to the needle carrier to facilitate movement ofthe needle carrier between a retracted position and a deployed position.13. The suturing instrument of claim 12, further comprising: an actuatorcoupled to a proximal end of the deployment controller.
 14. The suturinginstrument of claim 12, wherein the deployment controller is configuredto guide the needle carrier along a path that comprises a curved pathsegment leading initially away from the distal tip assembly and thentowards the distal tip assembly.
 15. The suturing instrument of claim11, further comprising: a suture coupled to the needle.
 16. The suturinginstrument of claim 12, further comprising: a flexible drive membercoupling the deployment controller to the needle carrier.
 17. Thesuturing instrument of claim 11, wherein the distal tip assembly ismovably coupled to the elongate body member such that the distal tipassembly is free to rotate about a longitudinal axis with respect to theelongate body member.
 18. The suturing instrument of claim 11, whereinthe distal tip assembly is movably coupled to the elongate body memberat a pivot joint such that the distal tip assembly is free to deflectabout the pivot joint.